This project asserts that the current discussion of health care cost containing strategies is dangerously one-sided in that it emphasizes their economic to the exclusion of their political implications. Cost containment strategies involve innovations and modifications that will affect the structure and functioning of regional health care delivery systems, the methods of paying for health care services, and the demands placed upon those services. While anticipated economic benefits may provide the incentive to experiment with new techniques, their successful implementation will depend heavily upon the ability of HSAs to cope with the political and institutional problems that they will generate. Implementation will require a full understanding of the capacity of each regional health care delivery system and its institutions to initiate, absorb, and sustain innovative action; and the conscious adoption of approaches which recognize and respect the realities of local policy making processes and environments. In this context the purpose of this project is to focus attention on the political and institutional aspects of the various cost containing approaches. Its basis will be the large and available body of literature, both theoretical and empirical, in the fields of public policy and administration, organization theory, social change theory, and health care politics. This literature will be subjected to an action-oriented analysis to identify and synthesize concepts relevant to the implementation of each cost containment technique. This will in turn be used to formulate selection criteria which represent the critical factors that HSAs should take into account as they implement their cost containing objectives. These criteria will identify the institutional structures, the environmental relationships, and the decision making processes which will either counteract or compound the problems of implementing cost containing initiatives.